MEDICARE: DEBORAH MARIE CANNON HOME HEALTH AIDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	NC10008711	WA

General Provider Information

NPI Number	:	1053156695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH MARIE CANNON HOME HEALTH AIDE

Provider Business Mailing Address
First Line	:	838 W AXTON RD TRLR 4
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-9641
Country	:	US
Telephone Number	:	425-239-7144
Fax Number	:

Provider Business Practice Location Address
First Line	:	838 W AXTON RD TRLR 4
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-9641
Country	:	US
Telephone Number	:	425-239-7144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2024
Last Update Date	:	06/26/2024

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